Application for registration as a pharmacy technician

Transcription

1 Application for registration as a pharmacy technician EEA nationals with EEA pharmacy technician qualifications Pharmacy Technician Registration General Pharmaceutical Council 25 Canada Square, London E14 5LQ info@pharmacyregulation.org Tel:

2 Introduction You should use this application pack if you are an EEA (European Economic Area) or Swiss national and want to apply to register as a pharmacy technician in Great Britain and one of the following apply: You have a pharmacy qualification gained in a member state that entitles you to practise as pharmacist or pharmacy technician in that country and if the education and training is not regulated in that member state, you have full-time professional experience as a pharmacy technician for two years, or equivalent period on a part time basis during the previous ten years. You have a pharmacy qualification gained in your country of qualification, that entitles you to practice as a pharmacist or pharmacy technician in that country, which has been recognized by a member state and you have been permitted to work as a pharmacist or pharmacy technician in that member state. We will evaluate your education and training and decide whether you are eligible for registration or not. You may be required to complete either an adaptation period or an aptitude test covering theoretical knowledge and practical skills, which have not been covered as part of your education and training, in order to meet our registration requirements. On 1 July 2011 registration became mandatory (compulsory). You will need to be registered as a pharmacy technician to work as or call yourself a pharmacy technician in Great Britain. What is registration for? Protection of title. Registration is your licence to practise as a pharmacy technician. Only those who meet and maintain recognised professional standards will be able to register and practise as pharmacy technicians and use the title. Professional recognition We approve new qualifications and set other criteria for entry onto the register. We define the standards for the training and education of pharmacy technicians.

3 Upholding the reputation of pharmacy technicians The reputation of an entire professional group can be compromised by a few individuals who, through poor performance or misconduct, do not keep the same high standards as the rest of the group. We have powers to bring proceedings against any registered pharmacy technician who is considered to be practising in a way which puts the public at risk. Defined standards of professional conduct All registered pharmacy technicians must comply with the GPhC s Standards of Conduct, Ethics and Performance which sets out our expectations regarding the professional conduct of pharmacists and pharmacy technicians. Once registered you will need to have indemnity arrangements in place. You may already be covered by your employer s insurance but it is your responsibility to check that you are appropriately covered. Maintaining professional competence Keeping up to date in your role as a pharmacy technician is vital. All pharmacy technicians, on the GPhC Register, must undertake continuing professional development (CPD). See website CPD enables registered pharmacy technicians to demonstrate to employers, the NHS and patients that they are maintaining and building on their capabilities. CPPE provide online study packages and workshops throughout the UK, to help pharmacy technicians stay up to date. These are free to registered pharmacy technicians. Guidance documents you should be familiar with The following documents can be downloaded from our website Standards of conduct, ethics and performance Standards for continuing professional development Criteria for initial registration as a pharmacy technician Guidance on registration with the GPhC and Fitness to Practise. Advises how to answer the questions on the fitness to practise form. Character assessment framework. This lists the areas we will take into consideration when you have declared a conviction or police caution. Health assessment framework. This lists all the relevant points we will take into consideration when you have declared matters concerning your health. Something to Declare Form. To be completed if you have declared a conviction, caution or health matter.

4 Preparing and completing your application 1. Read all the guidance carefully. 2. Use a black ball point pen, WRITE IN BLOCK CAPITALS and mark boxes clearly to answer the questions on the application form. No liquid paper amendments or alterations of any other kind are permitted on the application form or certified copies of documents 3. To help us process your application as quickly as possible, please check your documents very carefully to make sure you have provided all that is required and in the format required (eg certified copy or original document). We recommend that you make use of the checklist provided in the information pack. 4. Arrange for any documents not in English, including notary certifications to be translated into English. 5. Contact the relevant authorities to arrange for them to send the relevant documents directly to us. 6. Check that all the names on your documents are spelt the same way and any changes in name can be tracked. If there are variations see below for advice. 7. A solicitor or notary can certify photocopies of your documents as true copies of the original. 8. Arrange for your photograph and section 6 of your form to be signed by an appropriate person 9. Send your completed application to us as instructed on the checklist. It is important that your application is double checked before sending it to us. If any information or documents are missing we will return your application and your registration will be delayed. We will charge 47 administration fee if we have to return applications for missing information more than once. Guidance on providing supporting documents Certified copies We recommend you send certified copies (not the originals) of the following documents: Birth certificate Marriage certificate or other acceptable document(s) (where appropriate) Passport or identity card. Qualification certificate Officials who can certify your documents include UK registered solicitors or commissioners for oaths, the legal equivalent in your home country, or a notary public in your home country.

5 The official must write on each photocopy: I certify that I have seen the original document and that this is a true copy, sign, date and provide an official solicitors stamp. If a document is not in English, you must provide an authorised translation in English, and the certified copy of the original language document. No liquid paper amendments or alterations of any other kind are permitted to certified copies. Translations for documents not in English Any document that is not written in the English language MUST be accompanied by a translation. You must provide the translation together with a solicitor certified copy of the document which is not in English. Translations must be carried out by a professional translator. The translator must sign and date the translation and provide their name and business address. The translator must also certify that they are authorised to translate from the particular foreign language into English, and that the translation produced is true and accurate. The certification must be on the same page as the translation or be attached to the translation. The translation must be a literal translation NOT an interpretation of the original document. All certifications and ink stamps on the original document must also be translated. Contact your embassy for a list of official translators. Certificates from the Competent Authority These certificates are usually provided by the Ministry of Health or the Ministry of Education in your home EEA member country). The certificate must state: the name or title of your qualification the name of the awarding institution The number identifying your qualification diploma/certificate and the date the diploma/certificate was issued the level of your qualification in relation to Article 11 of Directive 2005/36/EC and that the qualification you hold entitles you to work as a pharmacy technician, a pharmacist's assistant or pharmacist (as appropriate) in that country.

6 Letters of good standing and eligibility to practice (also known as a certificate of current professional practice (CCPS)) If the profession of a pharmacy technician is a regulated profession in the country in which you obtained your pharmacy technician qualification and/or in the country in which you practised as a pharmacy technician; We require a letter confirming your good standing and eligibility to practise from the country in which you obtained your qualification and from the country in which you practised if this is different. This document must be sent direct to our office, by the regulatory/professional authority. The authority must confirm that you have not been the subject of any disciplinary proceedings and that there are no disciplinary proceedings pending against you. If you are not currently or have never been registered with a regulatory/professional authority you must provide a letter from your authority confirming that if you wished to register with that authority, there is nothing adverse known about you which would prevent your registration and ability to practise as a pharmacy technician or pharmacist in your country of qualification. If the profession of a pharmacy technician is not a regulated profession in the country in which you obtained your pharmacy technician qualification and/or in the country in which you practised as a pharmacy technician - you are required to provide an extract of judicial record/police clearance from the country in which you qualified and from each country in which you have worked as a pharmacy technician. The judicial record does not need to be sent directly to the General Pharmaceutical Council. A letter of good standing/ccps or extract of judicial record/police clearance certificate must be provided for the country in which you qualified and if different for each country in which you have practised as a pharmacy technician or pharmacist in the last 5 years preceding this application for registration. These documents must not be more than 3 months old on the date they are received by us. Syllabus (curriculum) A syllabus is an outline and summary of topics to be covered in an education or training course. You should contact the educational facility where you completed your qualification to request a copy it is a far more detailed document than the academic transcript and includes information about exactly what was covered in each subject you studied.

7 Guidance for filling in the application form Section 1 Personal details Questions 1.2 and 1.3 Names The name you register under must be the same as the name you intend to practise under. If you wish to be registered in a different name to that printed on birth certificate you must provide: A certified copy of your marriage certificate or other acceptable documentation (for instance a Deed Poll or Certificate of Civil Partnership), or A statutory declaration B completed in front of a solicitor. Please contact us for a statutory declaration form. Your name on all the documents you submit must be exactly the same letter for letter, word for word. If there are any variations in your name within or between documents you must provide a declaration of those variations on the Statutory Declaration form, sworn before a solicitor in the United Kingdom or authorised British Embassy official in your home country. Please tell us if you change your name. If you change your name whilst we are processing your application, you must notify us in writing and send a certified photocopy of the relevant document (for instance a statutory declaration or marriage certificate). If you change your name after you are registered, you must notify us in writing within one month of the date of change with a certified copy of the relevant document. Question 1.5 Your address You must keep your contact details up to date. If you change your address you must notify us within one month of the date of change. Your registered address must be the address where you live, as this is the address we will use when we write to you. We will not publish this address on the publicly available Register. Question 1.10 Your address Please provide us with an address. We will contact you by if we require additional information or documents.

8 Section 2 Fitness to Practise Question 2.1 Previous applications You must tell us if you have previously: registered with the Royal Pharmaceutical Society of Great Britain (RPSGB) or the GPhC in the past as a pharmacist or pharmacy technician applied for registration with the RPSGB or GPhC as a pharmacist or pharmacy technician undertaken or applied to RPSGB or GPhC for pre-registration training. If any of the above applies, you must also tell us: the date of your application the type of application (for instance, was it made through transitional provisions, as an international application or were you applying to register as a pharmacist) any previous registration or pre-registration or application numbers you may have had any other information you think is relevant (for instance, if you began an application but then withdrew). Questions 2.2 and 2.3 Registration with other health regulatory bodies You must tell us if you are, or have been, registered with any other regulatory bodies either in the UK or overseas. If you are registered with more than one body please provide details on a separate sheet. Questions 2.4 to 2.10 Legal and disciplinary proceedings We define a conviction as a finding, in criminal proceedings in the UK (or elsewhere), that a person has committed the offence alleged. You do not need to include road traffic offences where you were offered the option of paying a fixed penalty. This is even if you refused the option of paying the fixed penalty and were convicted of the offence by a court. You must tick either yes or no for questions 2.4 to If you have answered yes to any of the questions you must complete the Something to Declare form. You must tell us if you have been involved in any legal or disciplinary proceedings including any that have resulted in a caution or if you have any problems with your physical or mental health that may impair your ability to practise. Failure to do so may result in misconduct allegations at a later stage.

9 Section 3 Education and training Question 3.1 Title of qualification Provide the title of your qualification. Question 3.2, 3.3 Name and address of awarding institution Provide the name and address of the awarding institution. Question 3.4 Date commenced Provide the month and year you started the course Question 3.5 Date awarded Provide the month and year you were awarded the qualification Question 3.6: Mode of study Provide details of the mode of study, for instance if it was full time or part time. Question 3.7 Work experience Give details of any compulsory periods of work experience required as part of your qualification. If you have more than one qualification please continue on a separate sheet. Section 4 Career History Only include work experience after the date you started your pharmacy technician course, even if you were working in pharmacy before you started your course. You must provide information on your work experience as a pharmacy technician and student technician, including main responsibilities and duties. Please include a job description if you have one that provides details of your duties and responsibilities. Only include work experience that is pharmacy-related. You must provide a CV if there are gaps between jobs, because e.g. you have been travelling, you have taken any maternity leave or periods of sickness, or there have been any changes in hours or responsibilities.

10 Section 5 Declaration by applicant The GPhC register is divided into Parts. Part 2 is for registration as a pharmacy technician. You must sign and date the declaration. Fraudulently procuring an entry in the pharmacy technicians register will be treated as misconduct and may result in removal from the Register. Section 6 Photograph certification guidance You must provide one recent passport sized photograph. This must be signed on the back by an appropriate official. The photograph must be attached to the photograph certification page of your application form. The person who signs the photograph (the counter signatory): Must be a professional person, or a person of standing in the community. Examples include a pharmacist, registered pharmacy technician, a UK registered solicitor or a licensed Medical Practitioner. If you have any questions about who is an appropriate official contact us. Must have known you for at least 2 years Must not be related to you by birth or marriage. Neither should they be in a personal relationship with you e.g. husband and wife, nor live at your address. Must write on the back of the photograph the words I certify that this is a true likeness of (give full name of the applicant) They must also sign and date the back of the photograph. They must also complete the photograph certification page of the application form giving their full name, occupation and sign and date the form. Photograph Certification Requirements for the photograph The photograph must be: Taken within the last month In colour Against an off-white, cream or light grey plain background so your features are clear visible Printed on low-gloss, plain-white photo-quality paper Undamaged, for example, by creases from paperclips Of you on your own In sharp focus and clear Have a strong definition between the face and background

11 The photograph must show: No shadows You facing forwards, looking straight towards the camera A neutral expression, with your mouth closed (no obvious grinning, frowning or raised eyebrows) Your eyes open and clearly visible (no sunglasses or heavily tinted glasses and no hair across your eyes) No reflection or glare on your glasses, and the frames should not cover your eyes Your full head, without any head covering, unless it is worn for religious beliefs or medical reasons Nothing covering your face. Please ensure that nothing covers the outline of your eyes, nose or mouth. Section 7 Assessment framework The Assessment Framework describes the national requirements for the initial education and training of pharmacy technicians. This self assessment must be completed using and referencing your syllabus (curriculum). For any aspect of the framework which you mark yes you must also indicate the course/subject where this aspect was covered. You must indicate the subject in such a way to enable the Council s evaluators to cross-reference what you have written against your syllabus (curriculum), each reference on the assessment framework should be paged numbers to enable the evaluators to quickly locate the relevant section of the syllabus. For example, if your syllabus (curriculum) uses course codes then you must provide these on the Assessment Framework. Otherwise, you must use the indexing system used in your curriculum, for example, year of study, department, semester, subject title etc. Please ensure that your Assessment Framework is completed correctly and clearly. If this does not accurately reflect your syllabus you will be required to complete it again. Please note if the National Occupational Standards (NOS) have been covered by training or employment please provide an assessment from your supervisor/employer of your performance against the relevant standard. This can be provided on a separate sheet. This assessment(s) must be accompanied with a copy of your job description (detailing your role) and your supervisor/employer (s) must provide comment on your performance against this role.

12 This assessment and job descriptions will enable the GPhC s assessors to compare your work experience against the national requirement for education and registration. The assessors will make a recommendation regarding your eligibility for registration with the GPhC. It is possible that you may need to complete further education or undertake supervised practice as a pharmacy technician in the UK before being eligible to register. Please note that you must commence the module (s)/required period of supervised practice within 2 years from the date of the GPhC s decision letter, complete it satisfactorily and apply to register within four years of the date of this letter. If you do not start within 2 years or fail to satisfactorily complete the module (s) / period of supervised practice and apply to register within four years from the date of this letter your application will be timed out and you will be required to make a fresh application to register. Section 8 Equality Monitoring Form You are not required to provide this information if you do not wish to do so. Section 9 Payment for application for registration as a pharmacy technician When you apply to register with us you need to pay the following fees 1. The application fee. This covers our costs for checking the documents you have provided 2. The scrutiny fee. This covers our costs for evaluating your qualification against the national requirements for registration. 3. After satisfactory completion of the recommendations set by the Evaluators you will be required to provide the first entry fee. This covers our costs for putting and maintaining your name on the register. You need to submit the application fee and scrutiny fee with your application. We will contact you for the first entry fee once the evaluation of your application has been completed if your application has been successful. Please note: The current fees are provided in section 9 of the form. You must make your payment by credit or debit card. We do not accept cheque payments. You should complete section 9 of the form providing your card details. You will not be registered as a pharmacy technician until we have taken the application, scrutiny and first entry fee and you have checked on our on-line register search facility that your name appears on Part 2 of our register.

13 Do not send your application to the GPhC unless you have provided all the below documentation, including correctly certified documents and authorised translations, and arranged for any direct documents to be sent. Registration application checklist: Application form (including photograph certification) Payment form Birth certificate certified copy (and/or statutory declaration) Marriage certificate/s (if you are married) certified copy (or statutory declaration) Qualification certificate certified copy Passport certified copy of the identification page of your passport Photograph attached to section 6 photograph certification section Stamped self addressed postcard for confirmation that we received your application The syllabus (detailed curriculum) of your qualification Academic transcript of your qualification from your awarding body (college/university) Assessment Framework CV and job description If the National Occupational Standards (NOS) have been covered by training or employment please provide a detailed job description and assessment from your supervisor/employer of your performance against the relevant standard. Extract of judicial record/police Clearance certificate Direct documents A certificate from the Competent Authority in your Country. A letter of good standing (CCPS) from the country of qualification and any other regulatory body that you have been registered with in the last 5 years.

14 Send your completed forms and other documents to Pharmacy Technician Registration, General Pharmaceutical Council, 25 Canada Square, LONDON E14 5LQ Please note we will not accept liability for any loss as a result of completed applications not reaching us. Recorded delivery is recommended. Keep a copy of your application in case the original does not reach us. A stamped addressed postcard must be enclosed with your application for us to acknowledge receipt. The GPhC is a data controller registered with the Information Commissioner s Office. The GPhC makes use of personal data to support its work as the regulatory body for pharmacists, pharmacy technicians registered pharmacies in Great Britain. We may process your personal data for purposes including updating the register, administering and maintaining registration, processing complaints and compiling statistics. The GPhC will not share your personal data on a commercial basis with any third party. We may share your data with third parties to meet the GPhC's statutory aims, objectives, powers and responsibilities under the Pharmacy Order 2010, the rules made under the Order and other legislation. We may pass information to organisations with a legitimate interest including other regulatory and enforcement authorities, NHS trusts, employers and Department of Health. We may also share information with universities and research institutions for the purpose of research. In some circumstances, the GPhC may use the European Commission s Internal Market Information System (IMI) to share your personal data with relevant competent authorities in other European member states. This would usually be where we need to clarify information you have provided against records held by other authorities. You have the right to request a copy of any records held on you in the IMI and to have your data corrected. For contact details and other information about IMI, see the IMI website. We will publish pharmacists and pharmacy technicians fitness to practise records on our website as described in the Publication and Disclosure Policy.

15 1.1 Title 1. Personal details Mr Mrs Ms Miss Other (please specify) 1.2 Surname(s) 1.3 Forename(s) 1.4 Date of birth 1.5 Address including postcode 1.6 Country 1.7 Nationality 1.8 Home phone 1.9 Work phone / mobile address

16 2. Fitness to practise 2.1 Have you ever applied previously for registration with the Royal Pharmaceutical Society of Great Britain (RPSGB) or the General Pharmaceutical Council (GPhC), either as a pharmacy technician or as a pharmacist or undertaken preregistration training with the RPSGB or the GPhC? Yes No If you have answered yes to question 2.1 please provide details, including your application, registration or preregistration number 2.2 Are you currently or have you previously been registered with any UK statutory health regulatory body (any member body of the Council for Healthcare Regulatory Excellence) or a health regulatory body outside Great Britain? Yes No If you have answered yes to question 2.2 please provide name of body and registration number and a letter of good standing. By virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 and the Rehabilitation of Offenders Act 1974 (Exclusions and Exceptions) (Scotland) Order 2003, you are exempt from the provisions of Section 4(2) of the Rehabilitation of Offenders Act Therefore you are not entitled to withhold information about convictions which for other purposes are spent under the provisions of the Act and failure to disclose such convictions could result in disciplinary action 2.3 Has a determination ever been made against you by a regulatory body in the United Kingdom responsible under any enactment for the regulation of a health or social care profession to the effect that your fitness to practise as a member of a profession regulated by that body is impaired, or a determination by a regulatory body elsewhere to the same effect? Yes No 2.4 Do you currently have any problems with your physical or mental health that may impair your ability to practise safely and effectively or which otherwise impairs your ability to carry out your duties in a safe and effective manner? Yes No 2.5 Have you previously been convicted or cautioned for a criminal offence in the British Islands or elsewhere (which, if committed in England, Scotland or Wales would constitute a criminal offence) or

17 have you previously agreed to be bound over to keep the peace by a Magistrates Court in England or Wales? Yes No Please note that Road Traffic offences in which the person committing the offence has been offered the option of paying a fixed penalty (e.g. certain speeding offences etc) will not be treated as a conviction for the purposes of renewal in the Register and need not be declared. 2.6 Have you previously agreed to pay a penalty under section 115A of the Social Security Administration Act 1992 (penalty as alternative to prosecution)? Yes No 2.7 Are you currently or have you ever been under investigation by any regulatory body (other than the GPhC) or criminal enforcement authority (e.g. police or NHS Counter Fraud Service) in the British Islands or elsewhere? Yes No 2.8 Have you previously accepted a conditional offer under section 302 of the Criminal Procedure (Scotland) Act 1995 (fixed penalty: conditional offer by procurator fiscal) or have you previously been subject to an order under section 246(2) or (3) of the Criminal Procedure (Scotland) Act 1995 discharging you absolutely (admonition and absolute discharge)? Yes No 2.9 Have you previously been included by the Independent Safeguarding Authority (also known as the Independent Barring Board) barred list (in England, Wales or Northern Ireland) or the children s list or adult s list maintained by the Scottish Ministers? Yes No 2.10 Are you currently, or have you ever been, the subject of Fitness to Practise proceedings from your academic institution or the subject of disciplinary proceedings during any training placement or employment that resulted in a sanction of suspension or dismissal in the British Islands or elsewhere? Yes No If you have answered yes to any of the questions above you are required to submit a something to declare form with your application. The something to declare form is available on our website by at pharmacytechnician@pharmacyregulation.org and by telephone on

18 3. Education and training Please provide evidence of qualification (s) and/or professional experience. If you have additional relevant qualifications, please provide further details on a separate sheet of paper. This is recommended as this could affect the assessment of your application by the GPhC s evaluators. All qualifications must be accompanied by a detailed syllabus (curriculum) and an academic transcript (please see the Documentation section for further information. 3.1 Title of qualification 3.2 Name and address of awarding institution 3.3 Country 3.4 Date commenced (month and year) 3.5 Date awarded (month and year) 3.6 Mode of study (for instance full time, part time day release) 3.7 If you training included any periods of mandatory work experience, please provide details

19 4. Career history Applicants should provide their full career history as a pharmacy technician and student technician starting with their most recent role. A. Most recent job title / position Name and address of organisation Hours worked per week Start date (dd/mm/yy) End date (if applicable) (dd/mm/yy) Main responsibilities / duties please provide job description Name and job title of most recent line manager / supervising pharmacist (delete accordingly) Contact number of most recent line manager / supervising pharmacist (delete accordingly)

20 B. Job title / position Name and address of organisation Hours worked per week Start date (dd/mm/yy) End date (if applicable) (dd/mm/yy) Main responsibilities / duties please provide job description Name and job title of most recent line manager / supervising pharmacist (delete accordingly) Contact number of line manager / supervising pharmacist (delete accordingly)

21 C. Job title / position Name and address of organisation Hours worked per week Start date (dd/mm/yy) End date (if applicable) (dd/mm/yy) Main responsibilities / duties please provide job description Name and job title of most recent line manager / supervising pharmacist (delete accordingly) Contact number of line manager / supervising pharmacist (delete accordingly)

22 5. Declaration by applicant I declare that 5.1 I am applying for registration in Part 2 of the Register and I hereby declare that, in accordance with Article 20(3) of the Pharmacy Order 2010, I intend to practise as a pharmacy technician in Great Britain, the Channel Islands or the Isle of Man. 5.2 The information that I have provided in this application for registration is complete, true and accurate. I am also aware that I am under a duty to notify the Registrar of any changes to my name, home address or other contact details within one month starting on the day on which the change occurred. 5.3 I will adhere to the standards relating to conduct, ethics and performance and continuing professional development published by the General Pharmaceutical Council. 5.4 I have in place, or will have by the time I start to practise, appropriate cover under an indemnity arrangement that complies with Article 32 of the Pharmacy Order. Appropriate cover under an indemnity arrangement means cover against liabilities that may be incurred which is appropriate, having regard to the nature and extent of the risks associated with my scope of practice. 5.5 I accept that I am under a duty to notify the Registrar if there is any change in the circumstances relating to the fitness to practise declaration that I have made in Section 2 within 7 days starting on the day on which the event occurred. I understand that 5.6 If I am found to have given false or misleading information in connection with my application for registration, this may be treated as misconduct, which may result in my removal from the Register. Signature Date

23 6. Photograph certification This section must be completed by the person who signs the back of the photograph 6.1 Name 6.2 Address 6.3 Country 6.4 Phone 6.5 address By countersigning this application, you agree that the General Pharmaceutical Council (GPhC) may contact you to verify the information that you have provided. I declare that I have signed the photograph enclosed and that I have known for years and the information I have provided is correct. Signature Date I certify this is a true likeness of Give applicants full name and title Signature of certifying person and date certified Attach photograph here by one corner All writing must be visible

24 8. Equality monitoring 8.1 What is you ethnic group? Please tick one White British Irish Other Black or Black British Caribbean African Other Mixed White and Black Caribbean White and Black African White and Asian Other Mixed (please specify) Asian or Asian British Indian Pakistani Bangladeshi Other Asian (please specify) Other ethnic group If other please specify 8.2 What is you gender? Please tick one Male Female Other 8.3 What is your religion? Please tick one None Christian Buddhist Hindu Jewish Muslim Sikh Other If other please specify 8.4 Do you consider that you have a disability? Please tick one Yes No

25 9. Payment for application for registration as a pharmacy technician 9.1 Name of applicant Please charge this card with the sum(s) Application fee 102 Scrutiny fee 194 We will process your application fee and scrutiny fee payment when we validate your application Please indicate whether you are paying by Debit card Credit card Payment by credit card will incur a surcharge of 2% from 1 Sept 2011 onwards Type of card Please tick one Mastercard Visa Visa Purchasing Visa Delta Card number (insert the exact amount of digits in your card number only) CSC number (The last 3 digits on the back) of the card) Valid From Date / Expiry Date / Issue number If your card does not have an issue number please enter NA in the boxes. Name of cardholder Address of cardholder The name exactly as it appears on the debit or credit card digits in your card number only) Postcode digits in your card number only) Signature To be signed by the cardholder Date (dd/mm/yy)

26 If you are eligible to register we will contact you to provide the first entry fee payment as this may be up to 4 months from receipt of a complete application. This fee will only be collected after your application has been evaluated by the assessors and they have determined that you are appropriately qualified for registration. The first entry fee covers the costs of maintaining your name on the register of pharmacy technicians for twelve months from the date of first entry. The fee of 108 is the first entry fee for applicants entering onto the register up to and including September The fee for entrance onto the register after this date will be the subject of a GPhC fees consultation and may be higher. Please note Fees are non-refundable. The GPhC does not accept cheque payments You are required to provide two payments, the application fee and the scrutiny fee with your application. The application fee and scrutiny fee covers the cost of processing your application. We will process the application fee when we receive and check your application. We will process the scrutiny fee when we send your application for evaluation. The first entry fee covers the costs of maintaining your name on the register of pharmacy technicians for twelve months from the date of first entry. We will only process the first entry fee payment when your name is put on the register. The first entry fee is required to enter you onto the Register of Pharmacy Technicians and you will not be registered until this payment has been processed. An additional 47 administration fee will be levied in the event of an application for registration having to be returned to the applicant more than once.